Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208100000X | Physical Medicine & Rehabilitation Doctor | 9518 | MA |
NPI | 1003397183 |
---|---|
Provider Name | Jennifer Koot |
First Address | Newton Highlands, MA 02461-2011 |
Second Address | Newton, MA 02464-1297 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/08/2018 |
Last Update Date | 27/08/2018 |